A Phase II Study of Dovitinib in Recurrent and/or Metastatic Adenoid Cystic Carcinoma of the Salivary Glands

Inclusion criteria

• Histologically or cytologically confirmed ACC of major or minor salivary glands.
• Recurrent and/or metastatic disease deemed progressive that is not amenable to surgery or curative radiotherapy.
• Measurable disease according to the Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1), defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter in the plane of measurement is to be recorded) with a minimum size of:

• > 10 mm by CT scan (CT scan slice thickness no greater than 5 mm).
• > 10 mm caliper measurement by clinical exam (lesion which cannot be accurately measured with calipers should be recorded as non-measurable).
• > 20 mm by chest X-ray Malignant lymph nodes: To be considered pathologically enlarged and measurable, a lymph node must be >15mm in short axis when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm).
• Progressive disease, defined as one of the following occurring within 12 months of study entry:

i) at least a 10% increase in radiologically or clinically measurable disease; ii) appearance of one or more new lesions, or iii) deterioration in clinical status.

Exclusion criteria

• Less than 18 years of age.
• Life expectancy < 12 weeks.
• ECOG performance status > 2.
• Known brain metastases.
• Treatment with chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
• Major surgery within 4 weeks prior to entering the study.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to dovitinib.
• Taking medications that are potent CYP3A4 inducers or inhibitors (dovitinib is metabolized primarily by the CYP3A4 liver enzyme, every effort should be made to switch patients taking such agents or substances to other medications).
• History of cardiac dysfunction with an ECHO or MUGA scan outside the institutional range of normal.
• QTc prolongation (defined as a QTc interval > 500 msec) or other significant ECG abnormalities.
• Poorly controlled hypertension (systolic blood pressure of ≥ 140 mmHg or diastolic blood pressure of ≥ 90 mmHg).
• Any abnormal organ and marrow function as defined below:

• Leukocytes <3,000/microL
• Absolute neutrophil count <1,500/microL
• Platelets <100,000/microL
• Total bilirubin >1.5X institutional upper limit of normal (ULN)
• AST(SGOT) / ALT(SGPT) >2.5X institutional ULN
• Amylase/lipase outside normal institutional limits
• Serum creatinine >1.5X ULN
• Creatinine clearance <60mL/min/1.73 m2 for patients with creatinine levels above institutional normal
• Required use of therapeutic doses of coumarin-derivative anticoagulants such as warfarin, although doses of up to 2mg daily are permitted for prophylaxis of thrombosis. Note: Low molecular weight heparin is permitted provided the patient's PT INR is ≤ 1.5.
• Pre-existing condition (e.g., gastrointestinal tract disease), resulting in an inability to take oral medication or a requirement for IV alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease that impairs their ability to swallow and retain dovitinib tablets.
• Pre-existing thyroid abnormality with an inability to maintain thyroid function in the normal range with medication.
• Any of the following conditions:

• Serious or non-healing wound, ulcer, or bone fracture,
• History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 28 days of treatment,
• History of cerebrovascular accident (CVA) or transient ischemic attack (TIA) within 12 months prior to study entry,
• History of pulmonary embolism within the past 12 months,
• History of myocardial infarction, cardiac arrhythmia, stable/unstable angina, symptomatic congestive heart failure, or coronary/peripheral artery bypass graft or stenting within 12 months prior to study entry,
• NYHA Class III or IV heart failure as defined by the NYHA functional classification system.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infections, HIV-positive patients on combination antiretroviral therapy.
• Pregnant or lactating women.
• Psychiatric illness/social situations that would limit compliance with study requirements.
• Receiving any other investigational agent(s).
• Inability to understand or unable to provide written informed consent.